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Saturday 2, 2018

Once the conversation begins, it should be open-minded and open-ended, without judgment, blaming, or shaming. The discussion shouldn’t necessarily begin with the eating disorder, either. Dentists should approach it indirectly and see if the patient is willing to bring it up.

“Just say, ‘I’m really worried with what I’m seeing with your teeth. And there can be a lot of different reasons for it dental supplies. I’m noticing that there’s a lot of damage. Do you have any thoughts about what might be causing it?’ They might not open up at that point. You can continue with, ‘Some of the things that we’ve seen that cause problems like this are chronic vomiting or stomach acid. Are you having any problems like that?’” Levine said.

“Open-ended questions are a great way to get patients to talk with us, rather than going down a checklist, because people will tell us as much as they think we want to hear sometimes. If they think all we want to hear is ‘Yes, I have a problem’ or ‘No, I don’t have a problem,’ then that’s all we’re going to get, and we probably won’t really find out what’s going on. But if we really say ‘I’m interested in helping you. Can you tell me what might be going on?’ they will often provide much more information and really feel somebody is interested in helping them.”

If the patient is willing to discuss the disorder, then dentists should be prepared to provide referrals to specialists who may be able to help. Dentists also should ask if they can discuss the issue with the patient’s primary care provider. But some patients will rebuff the topic and even deny there is a problem in the first place. It may take multiple visits before the patient is willing to open up, if it happens at all.

“Put it in your chart or in your notes that you’ve had this conversation, and try again at the next appointment, especially if things are getting worse in any way,” Levine said. “Again, don’t be judgmental or shame the person. Just say, ‘I know we’ve talked about this before, but you’re still having a lot of these issues here, and I’m really worried about it. Let’s go through it again and really think about if there is something going on.’ That would be the main way I would say to approach it.”

Some of these patients may be adolescents, complicating matters in terms of confidentiality and parental permissions. Regulations vary and must be followed, though Levine notes that in adolescent medicine, she and her colleagues often start their conversations with the adolescents first and later bring in their parents. In some areas, patients as young as 14 or 16 years old may be able to make their own decisions about psychiatric treatment, she said.

“We never want to violate that, but we also want to make sure that we bring in the parents,” Levine said. “A lot of times it could be approached with the adolescent, and then just say, ‘You know, I think this is an important conversation to have. Let’s bring your mom or dad in to talk about what’s going on vacuum forming machine dental.’ But you’re going to have a lot more buy-in from the adolescent if you start with them first and then say, ‘This may be a tough conversation to have, so let’s bring your mom and dad in, and we can all do this together and help provide some support.’”

Levine also acknowledges that age and gender gaps may be difficult to overcome in these discussions. Young women, for example, may not be comfortable opening up to older men no matter how compassionate they are in bringing up their concerns. In those situations, younger female members of the staff may be better suited for initiating the communication, bringing others into the conversation as necessary.

“The most important thing is to have a basic understanding and approach the conversation in a calm way and not be judgmental, because a lot of these patients have already faced a lot of judgment from other people, including their families, who say, ‘I don’t understand it. Just eat,’ or ‘Just stop throwing up.’” Levine said scian nebulizer. “They get a lot of criticism at times from other places. So if they feel like somebody is really worried about them and is willing to talk and is not going to judge them, they will be much more willing to open up about it.”